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HOME OF PELICAN ISLAND
Certificate No. 2126
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Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian,
it is hereby certified that:
Larry Kerr
(name)
9265 81St Street, Vero Beach, FZ 32967
(address)
in and for consideration of the sum of $950.00 is entitled to full interment rights in the
Sebastian Municipal Cemetery for the following lot:
Unit 4_ Block 30_ Lot 33_
of the Sebastian Municipal Cemetery,
as maintained on file in the records of the City Clerk
for use in accordance with the conditions, ordinances, resolutions, rules and regulations
prescribed therefore by the City of Sebastian.
CONVEYED THIS 16~' day of April, 2007.
CITY OF
ity Manager
FLORIDA
ATTEST:
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Sally .Maio, MMC
ity Clerk
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April 16, 2007
Mr. Larry Kerr
9265 81~ Street
Vero Beach, FI 32960
RE.• Interment Rights to Unit 4, Block 30, Lot 33, Sebastian Cemetery
Dear Mr. Leone:
Enclosed is City of Sebastian Certificate 2126 entitling you to full interment rights in
Unit 4, Block 30, Lot 33.
Also enclosed is a copy of the Rules and Regulations governing the Sebastian Municipal
Cemetery.
If you have any questions, please contact our office.
Sincerely,
`,. -
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Sally A. io, MMC
City Clerk
SAM:ar
enclosures
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Gity of Sebastian Municipal Cemetery
Purchase Receipt
To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery
rate regulations, residence of purchaser or person for whom lot is intended for interment must be
provided at time of purchase
Name(s) ~~--..--~~.. //~~ ~7 ~~~~,'
Area Code & Phone Number
Residence Address of Intended Occupant if Other Than Purchaser
Office Use Only
is acknowledged in the sum of: ,~
~~~ ~ ~ Dollars ($ ~~- 4~ )
~bn this ~~ day of U , 20~ for the purchase of the following
described Cemetery Lot(s) a d/or Niche(s).
Unit , Block~y~, Lot(s) -Niche(s)
for use in accordance with the conditions, ordinances, resolutions, rules and regulations
prescribed therefore by the City of Sebastian.
Additional Fees paid at time of purchase:
Comer Markers (set of 4 - $20) Opening 8~ Closing
Vase and Ring for Niches (cost)
Interment
W O H
Circle One
Disinterment
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ignatu of Purchaser
of Sebastian
Service fees are to be paid at time of need only
I:1W W-DATAU1As-Cemetery~RECEIPT_doc
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LARRY KERR
9265 81st Street
Vero Beach, FL 32967
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COX-GIFFORD-SEAWINDS FUNERAL HOME suNr~raaNK 971
1950 20TH STREET vERO BEACH, FL 32960
VERO $EACH, FZ 32960 63-215/631
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ORDER OFE ~` ~ ~'~ ~ ~. `'J ~'~-~ ~_ ~ ~ ~ ~ ~ ~
DOLLARS
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x'009???ii' ~:063i02i52~:i0000i?3?7762~i'
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FLOR[~~PA, RTMENT OF O Q
HEALT S~APPLICATION FOR BURIAL HTaRAN IT PERM Tics
A. (TYPE)
1. Name of First Middle Last Date Month Day Year
Deceased of
HARRIET CATHERINE KERB Death APRIL 13 2007
2. Place of Death City, Town or Location Name of (If neither, give street address)
County Hosp. or
INDIAN RIVER VERO BEACH Inst. TIQDiAIV' RIVER MEDICAL CENTER
3. Name of Medical Address Phone Number
Certifier TAHER HUSAINY, M.D. 777 37TH STREET, SUITE D-105 772-770-0808
Medical Examiner Physician VERO BEACH, FL
4. Name of Funeral Home/Direct Disposal Address Fla. Lic. No./Reg. No. Phone No. (Area Code)
EstablishmentCOX-GIFFORD-SEAWIND 1950 20TH STREET 2214 772-562-2365
FUNERAL HOME & CREMATORY VERO BEACH, FL
5. Check a. ® The medical certification has been completed and signed. A completed certificate of death accompanies this
Appropriate application.
Box
b.
He/she verified that
Medical Examiner, will complete and sign the
ical certfication of cause of death within 72 hours.
6. Funeral Diredod Sign tore ,- ~ F.E. No./Reg. No. Date Signed -~
,. 4103 ~~~`~1
Direct Disposer y.~~ ~/~~,~r,~'~%-~ _ "`
g. BURIAL -~NSIT PERMIT
Permission is hereby granted to dispose of this body. Permit No. 07-2214-180
®A five (5) day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted since the physician has
been contacted by the funeral director and will not be able to complete the medical cert~cation of cause-of-death section of the death certificate within
72 hours.
~No extension of time for filing the death certficate has been requested.
Registrar or Date Date Certficate
Subregistrar Signature~,~~~~/.± C-ti ~~~ Issued: 4 / 13 / 07 _ -Due: 4 / 25 / 0 7
c.
Approval Number:
Date
Medical Examiner, ,gave authorization by telephone to
Funeral Director/Direct Disposer. Date
The Medical Examiner's approval must be obtained before disposal by any of the above methods. Awaiting period of 48 hours after death is
required for all cremations.
D.
Method of Disposition:
BURIAL
CREMATION
Signature of Sexton
or Person-in-Charge
was contacted on
He/she verified that this death was from natural causes, that there was no accident nor other external cause of death,
and that will complete and sign the medical
cert~cation of cause of death within 72 hours.
c. ~ was contacted on
STORAGE
OTHER (Specify)
CEMETERY OR CREMATORY _ ~.--;
Place of Disposition ~,~~
Date of Disposition ~/l~/~ ~•
This permit must be endorsed by the Sexton or person-in-charge (or by the Funeral Director/Direct Disposer when there is no Sexton) and .returned
within 10 days to the local County Health Department m.the county where d(sposition occurred.
AUTHORIZATION for CREMATION, DISSECTION, or BURIAL-AT-SEA
Distribution: White: cemetery or crematory
DH~326, 8/97 (Obaoletes all previous edkions) Yelknv: Funeral Director or Direct Disposer
(Stock Number. 5740-000-0326-2) Pink: t.ocal Registrer y~,r i~ ~